Emergency managers are responsible for managing crises and disasters, and while their work is essential, it can be stressful and impact their mental health, particularly during the COVID-19 pandemic. This study aimed to examine the mental health of professional emergency managers and factors associated with their intent to leave the field before and during the COVID-19 pandemic. A total of 903 respondents completed an online survey assessing their secondary traumatic stress, emergency reaction strategies, organizational culture, age, length of time in primary position, the highest level of education as well as other metrics. The Secondary Traumatic Stress Scale (STSS) was used to determine scores of secondary traumatic stress symptoms, and the Emergency Reaction Questionnaire (ERQ) index was used to evaluate levels of predominant personality types and its tendency towards "fight or flight" reactions in emergency situations. Results revealed significant differences among respondents who reported considering leaving the field before or during the COVID-19 pandemic in terms of secondary traumatic stress scores, ERQ levels, perceived organizational culture (OC), age category, length of time in primary position, and the highest level of education (p < 0.05). Logistic regression analysis indicated that respondents with higher secondary traumatic stress scores, poorer organizational culture, younger age, less experience, and a bachelor's degree had nearly three times the odds of reporting considering leaving the field (p < 0.05). Additionally, respondents with a graduate degree had nearly four times the odds of reporting leaving the field (p < 0.05), while those who had directly managed between three and five disasters had nearly two times the odds of reporting and considering leaving the field (p < 0.05). These findings underscore the importance of addressing secondary traumatic stress, promoting positive organizational culture, and providing support for emergency managers now and in the future. By addressing the factors identified in this study, such as secondary traumatic stress symptoms, promoting positive organizational culture, and providing adequate support, emergency management organizations can improve the mental health and well-being of their personnel, reduce attrition rates, and ensure that they are better equipped to respond to future crises.
This paper presents a simulation modeling study that examines the potential benefit of arming public school staff members with concealed carry weapons (CCWs) in combination with school resource officers (SROs) during active shooter events. By simulating real or hypothetical situations and altering various parameters, simulation modeling allows researchers to explore the potential factors that may influence the outcome of such situations. This study will analyze literature on active shootings to identify key characteristics that may impact the outcome of an event and will use an actual school active shooter event as a basis for developing a simulation model. The researchers will then introduce a CCW carrier and an SRO into the scenario to assess the potential impact and outcomes of such a change. The results of this study may inform the development of effective policies and procedures for addressing active shooter events in public settings.
During disasters, emergency management and health agencies are typically the key providers of healthcare services, yet communication breakdowns between the two sectors often hinder response. This qualitative study explores the experiences of emergency managers and health professionals to identify challenges in cross-agency collaboration. Semi-structured interviews were conducted with professionals from New Zealand and the United Nations Office for the Coordination of Humanitarian Affairs. Inductive thematic analysis revealed three key challenges: structural, operational, and information exchange barriers. Weak interpersonal relationships and lack of prior liaison were found to impede information sharing, reducing situational awareness. Coordination was further undermined by inadequate training, insufficient funding, and reliance on untrained personnel. Rigid planning structures, limited community engagement, and the exclusion of vulnerable groups also weakened response efforts. Overly complex reporting structures and fragmented information systems restricted effective data sharing, with privacy concerns further constraining access to critical information. Interoperability challenges further disrupt the seamless flow of information across disaster response agencies. Finally, the absence of robust auditing and accountability mechanisms highlighted the need for reinforced governance frameworks and institutionalised performance evaluations to enhance disaster resilience and response effectiveness. Identifying barriers to effective communication and information sharing among key disaster response stakeholders provides valuable insights for refining emergency response strategies including the development of clear protocols, improved data integration, and the adoption of AI and digital tools to streamline reporting and enhance decision-making. These enhancements can lead to improved quality of care, faster recovery, and more efficient resource allocation during disasters, ultimately benefiting affected populations.
Abstract As emergency management evolved to encompass a focus on supporting safe growth and development for communities, the role and responsibilities of government became increasingly complex with aspects of emergency management becoming quintessential. Issues with communication uncovered the need to understand how managers collect, disseminate, and adapt critical information through understanding crisis type and local community needs. This paper examines the use of crisis communication strategies in emergency management practice and how these strategies have been impacted by Situational Crisis Communication Theory. This theory’s prescriptive approach connects leaders’ response to strategies emphasizing adaptation to local community needs and crisis type. Utilizing structural equation modeling and qualitative analysis, results from a nationwide survey of county, and county-equivalent, emergency managers in the United States is included. The survey focused on the relationship between crisis communication strategies, local community needs, crisis type, and perceived resilience. The paper concludes with a discussion of the significant indicators impacting use of crisis communication strategies by emergency managers along with critical importance of adaptation to local community needs and crisis type. In addition, the paper unveils practical recommendations for practitioners, policymakers, and researchers in the field of emergency management and its counterparts.
BACKGROUND: In Belgium, General Practitioner Cooperatives (GPC) aim to improve working conditions for unplanned care and to reduce the number of low acuity emergency visits. Although this system is well organized, the number of low acuity visits does not decrease. METHODS: We explored the view of patients and physicians on the co-location of a GPC and an emergency service for unplanned care. The study was carried out in a cross section design in primary and emergency care services and included patients and physicians. Main outcome measure was the view of patients and physician on co-location of a GPC and an emergency service. RESULTS: 404 patients and 488 physicians participated. 334 (82.7%) of all patients favoured a co-location. The major advantages were fast service (104, 25.7) and adequate referral (54, 13.4%). 237 (74%) of the GPs and 38 (95%) of the emergency physicians were in favour of a co-location. The major advantage was a more adequate referral of patients. 254 (79%) of the GPs and 23 (83%) of the emergency physicians believed that a co-location would lower the workload and waiting time and increase care quality (resp. 251 (78%), 224 (70%) and 37 (93%), 34 (85%). CONCLUSIONS: To close the expectation gap between GP's, emergency physicians and to reach for high care quality, information campaigns and development of workflows are indispensable for a successful implementation of a co-location of primary and emergency care.
BACKGROUND: Prevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines. OBJECTIVES: This study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice. METHODS: An integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used. RESULTS: Overall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of "planned behavior" and the "technology acceptance model" (n=3) suggests that social media use is mediated by an individual's positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions. CONCLUSIONS: There is emerging evidence that health care professionals use social media to develop virtual communities to share domain knowledge. These virtual communities, however, currently reflect tribal behaviors of clinicians that may continue to limit knowledge sharing. Further research is required to evaluate the effects of social media on knowledge distribution in clinical practice and importantly whether patient outcomes are significantly improved.
Unequivocal international guidelines regarding the diagnosis and management of patients with acute appendicitis are lacking. The aim of the consensus meeting 2015 of the EAES was to generate a European guideline based on best available evidence and expert opinions of a panel of EAES members. After a systematic review of the literature by an international group of surgical research fellows, an expert panel with extensive clinical experience in the management of appendicitis discussed statements and recommendations. Statements and recommendations with more than 70 % agreement by the experts were selected for a web survey and the consensus meeting of the EAES in Bucharest in June 2015. EAES members and attendees at the EAES meeting in Bucharest could vote on these statements and recommendations. In the case of more than 70 % agreement, the statement or recommendation was defined as supported by the scientific community. Results from both the web survey and the consensus meeting in Bucharest are presented as percentages. In total, 46 statements and recommendations were selected for the web survey and consensus meeting. More than 232 members and attendees voted on them. In 41 of 46 statements and recommendations, more than 70 % agreement was reached. All 46 statements and recommendations are presented in this paper. They comprise topics regarding the diagnostic work-up, treatment indications, procedural aspects and post-operative care. The consensus meeting produced 46 statements and recommendations on the diagnostic work-up and management of appendicitis. The majority of the EAES members supported these statements. These consensus proceedings provide additional guidance to surgeons and surgical residents providing care to patients with appendicitis.
A review of the literature suggests that the application of self-adhesive hydrocolloid dressings, most commonly associated with the treatment of ulcerative conditions such as pressure ulcers and leg ulcers, may also offer benefits in the management of acute wounds of all types, for example decreasing healing times of donor sites by about 40% compared with traditional treatments. Healing times of superficial traumatic injuries and surgical wounds are similarly enhanced but in the treatment of burns, the principal benefit appears to be a reduction in wound pain, an effect that has also been reported in virtually all other wound types. The impermeable nature of hydrocolloids provides a protective covering to the wound, permitting washing or showering while helping to prevent the spread of pathogenic microorganisms. There also appear to be significant cost-benefits associated with the use of hydrocolloids. In recent years, hydrocolloid dressings have been replaced by other products such as foams for the treatment of more heavily exuding wounds but for more lightly exuding wounds they still offer many practical advantages and as such will undoubtedly continue to meet an important need in wound management practice.
The paper presents a critical review of selected simulation models including (1) flow based, (2) cellular automata, (3) agent-based, and (4) activity-based models, as well as of three simulation models that incorporate social scientific processes--FIRESCAP, EXODUS, and the Multi-Agent Simulation for Crisis Management. It concludes by pointing out the so far ignored insights that could be derived from the fields of social psychology and social organization. A number of predictions regarding the effects of social organizational variables on the timing and movement of evacuating groups are presented. 2 A Critical Review of Emergency Evacuation Simulation Models We offer a critical review of selected simulation models of evacuation behavior based on published descriptions of their characteristics rather than on empirical tests of their claims (compare to Kuligowski, 2003). A second section of the paper identifies social sciences approaches that could improve present day simulation models. Our argument is that the social sciences could provide important new directions to simulation
BACKGROUND: This study focuses on how educating people through social media platforms can help reduce the mental health consequences of the COVID-19 to manage the global health crisis. The pandemic has posed a global mental health crisis, and correct information is indispensable to dispel uncertainty, fear, and mental stress to unify global communities in collective combat against COVID-19 disease worldwide. Mounting studies specified that manifestly endless coronavirus-related newsfeeds and death numbers considerably increased the risk of global mental health issues. Social media provided positive and negative data, and the COVID-19 has resulted in a worldwide infodemic. It has eroded public trust and impeded virus restraint, which outlived the coronavirus pandemic itself. METHODS: The study incorporated the narrative review analysis based on the existing literature related to mental health problems using the non-pharmaceutical interventions (NPIs) approach to minimize the COVID-19 adverse consequences on global mental health. The study performed a search of the electronic databases available at PsycINFO, PubMed, and LISTA. This research incorporates the statistical data related to the COVID-19 provided by the WHO, John Hopkins University, and Pakistani Ministry of Health. RESULTS: Pakistan reported the second-highest COVID-19 cases within South Asia, the fifth-highest number of cases in Asia after Iran, India, Russia, Saudi Arabia, and the 14th highest recorded cases, as of October 14, 2020. Pakistan effectively managed the COVID-19 pandemic in the second wave. It stands at the eighth-highest number of confirmed cases in Asia, the 3rd-highest in South Asia, and the 28th-highest number of established patients globally, as of February20, 2021. CONCLUSION: The COVID-19 has resulted in over 108.16 million confirmed cases, deaths over 2.374 million, and a recovery of 80.16 million people worldwide, as of February 12, 2021. This study focused on exploring the COVID-19 pandemic's adverse effects on global public health and the indispensable role of social media to provide the correct information in the COVID-19 health crisis. The findings' generalizability offers helpful insight for crisis management and contributes to the scientific literature. The results might provide a stepping-stone for conduct future empirical studies by including other factors to conclude exciting developments.
How did problems with subprime mortgages result in a systemic crisis, a panic? The ongoing Panic of 2007 is due to a loss of information about the location and size of risks of loss due to default on a number of interlinked securities, special purpose vehicles, and derivatives, all related to subprime mortgages. Subprime mortgages are a financial innovation designed to provide home ownership opportunities to riskier borrowers. Addressing their risk required a particular design feature, linked to house price appreciation. Subprime mortgages were then financed via securitization, which in turn has a unique design reflecting the subprime mortgage design. Subprime securitization tranches were often sold to CDOs, which were, in turn, often purchased by market value off-balance sheet vehicles. Additional subprime risk was created (though not on net) with derivatives. When the housing price bubble burst, this chain of securities, derivatives, and off-balance sheet vehicles could not be penetrated by most investors to determine the location and size of the risks. The introduction of the ABX indices, synthetics related to portfolios of subprime bonds, in 2006 created common knowledge about the effects of these risks by providing centralized prices and a mechanism for shorting. I describe the relevant securities, derivatives, and vehicles and provide some very simple, stylized, examples to show: (1) how asymmetric information between the sell-side and the buy-side was created via complexity; (2) how the chain of interlinked securities was sensitive to house prices; (3) how the risk was spread in an opaque way; and (4) how the ABX indices allowed information to be aggregated and revealed. I argue that these details are at the heart of the answer to the question of the origin of the Panic of 2007.
he ESC Guidelines represent the views of the ESC and were produced after careful consideration of the scientific and medical knowledge and the evidence available at the time of their publication. The ESC is not responsible in the event of any contradiction, discrepancy and/or ambiguity between the ESC Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the ESC Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and \naccurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the ESC Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.
BACKGROUND: Clinical practice is not always evidence-based and, therefore, may not optimise patient outcomes. Opinion leaders disseminating and implementing 'best evidence' is one method that holds promise as a strategy to bridge evidence-practice gaps. OBJECTIVES: To assess the effectiveness of the use of local opinion leaders in improving professional practice and patient outcomes. SEARCH STRATEGY: We searched Cochrane EPOC Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, HMIC, Science Citation Index, Social Science Citation Index, ISI Conference Proceedings and World Cat Dissertations up to 5 May 2009. In addition, we searched reference lists of included articles. SELECTION CRITERIA: Studies eligible for inclusion were randomised controlled trials investigating the effectiveness of using opinion leaders to disseminate evidence-based practice and reporting objective measures of professional performance and/or health outcomes. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from each study and assessed its risk of bias. For each trial, we calculated the median risk difference (RD) for compliance with desired practice, adjusting for baseline where data were available. We reported the median adjusted RD for each of the main comparisons. MAIN RESULTS: We included 18 studies involving more than 296 hospitals and 318 PCPs. Fifteen studies (18 comparisons) contributed to the calculations of the median adjusted RD for the main comparisons. The effects of interventions varied across the 63 outcomes from 15% decrease in compliance to 72% increase in compliance with desired practice. The median adjusted RD for the main comparisons were: i) Opinion leaders compared to no intervention, +0.09; ii) Opinion leaders alone compared to a single intervention, +0.14; iii) Opinion leaders with one or more additional intervention(s) compared to the one or more additional intervention(s), +0.10; iv) Opinion leaders as part of multiple interventions compared to no intervention, +0.10. Overall, across all 18 studies the median adjusted RD was +0.12 representing a 12% absolute increase in compliance in the intervention group. AUTHORS' CONCLUSIONS: Opinion leaders alone or in combination with other interventions may successfully promote evidence-based practice, but effectiveness varies both within and between studies. These results are based on heterogeneous studies differing in terms of type of intervention, setting, and outcomes measured. In most of the studies the role of the opinion leader was not clearly described, and it is therefore not possible to say what the best way is to optimise the effectiveness of opinion leaders.
BACKGROUND: Excessive workload may impair patient safety. However, little is known about emergency care providers' workload during the treatment of life-threatening cases including cardiopulmonary resuscitation (CPR). Therefore, we tested the hypothesis that subjective and physiological indicators of workload are associated with the patient's initial NACA score and that workload is particularly high during CPR. METHODS: NASA task load index (NASA-tlx) and alarm codes were obtained for 216 sorties of pre-hospital emergency medical care. Furthermore, initial NACA scores of 140 patients were extracted from the physicians' protocols. The physiological workload indicators mean heart rate (HR) and permutation entropy (PeEn) were calculated for 51 sorties of primary care. General linear mixed models were used to analyze the association of NACA scores with subjective (NASA-tlx) and physiological (mean HR, PeEn) measures of workload. RESULTS: In contrast to the physiological variables PeEn (p = 0.10) and HR (p = 0.19), the mental (p<0.001) and temporal demands (p<0.001) as well as the effort (p<0.001) and frustration (p = 0.04) subscale of the NASA-tlx were significantly associated with initial NACA scores. Compared to NACA = I, an initial NACA score of VI (representing CPR) increased workload by a mean of 389.5% (p = 0.001) in the mental and 345.9% (p<0.001) in the temporal demands, effort by a mean of 446,8% (p = 0.002) and frustration by 190.0% (p = 0.03). In line with the increase in NASA-tlx, PeEn increased by 20.6% (p = 0.01) and HR by 6.4% (p = 0.57). CONCLUSIONS: Patients' initial NACA scores are associated with subjective workload. Workload was highest during CPR.
In recent times, the emergence of the Metaverse has garnered worldwide attention as an innovative digital space that holds immense potential to provide a wide range of health services to medical professionals and patients. With increasing stress on healthcare systems, it has become crucial to explore the latest and cost-effective solutions that can provide fast and reliable medical services. The focus of this study, therefore, is to explore applications of metaverse in various health care systems and elaborate on how it can efficiently improve the clinical management of patients. Consequently, an in-depth assessment of the metaverse has been carried out, while covering its core fundamentals, key technologies, and diverse applications in healthcare and medicine, including but not limited to, emergency response learning, hands-on experience in anatomy learning, orthopaedics, paediatrics and so on. To carry out the study, we have used an exploratory approach to analyze qualitative data on healthcare metaverse services in our systematic review. Relevant articles from scientific databases such as Web of Science, Springer, Scopus, and IEEE have been identified, and the analysis has been conducted using the PRISMA reporting guideline to ensure transparent and comprehensive reporting. The results of the study suggest that the metaverse has the potential to transform healthcare systems by introducing novel methods for delivering healthcare services. Metaverse’s AR/VR technologies can enable remote medical consultations and training, benefiting patients and healthcare professionals. Additionally, patients can access health-related information and resources, empowering them to manage their health better and make more informed decisions.
In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis. These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US-Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States. Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis.
Abstract. This paper presents a comprehensive review and analysis of the available literature and information on droughts to build a continental, regional and country level perspective on geospatial and temporal variation of droughts in Africa. The study is based on the review and analysis of droughts occurred during 1900–2013, as well as evidence available from past centuries based on studies on the lake sediment analysis, tree-ring chronologies and written and oral histories and future predictions from the global climate change models. Most of the studies based on instrumental records indicate that droughts have become more frequent, intense and widespread during the last 50 years. The extreme droughts of 1972–1973, 1983–1984 and 1991–1992 were continental in nature and stand unique in the available records. Additionally, many severe and prolonged droughts were recorded in the recent past such as the 1999–2002 drought in northwest Africa, 1970s and 1980s droughts in western Africa (Sahel), 2010–2011 drought in eastern Africa (Horn of Africa) and 2001–2003 drought in southern and southeastern Africa, to name a few. The available (though limited) evidence before the 20th century confirms the occurrence of several extreme and multi-year droughts during each century, with the most prolonged and intense droughts that occurred in Sahel and equatorial eastern Africa. The complex and highly variant nature of many physical mechanisms such as El Niño–Southern Oscillation (ENSO), sea surface temperature (SST) and land–atmosphere feedback adds to the daunting challenge of drought monitoring and forecasting. The future predictions of droughts based on global climate models indicate increased droughts and aridity at the continental scale but large differences exist due to model limitations and complexity of the processes especially for Sahel and northern Africa. However, the available evidence from the past clearly shows that the African continent is likely to face extreme and widespread droughts in future. This evident challenge is likely to aggravate due to slow progress in drought risk management, increased population and demand for water and degradation of land and environment. Thus, there is a clear need for increased and integrated efforts in drought mitigation to reduce the negative impacts of droughts anticipated in the future.
Emergency logistics supply chains (ELSC) can help to restore normal activities in disaster-affected areas, thus helping to increase the resilience of communities. In order to develop resilient supply chains there needs to be an analysis of the factors affecting the vulnerability of supply chains. In this study, the interlinkages between 15 factors found to influence the vulnerability of both within and outside the ELSC were analysed through the D- Decision Making Trial and Evaluation Laboratory (D-DEMATEL)-Adversarial Interpretive Structure Model (AISM) modelling techniques. The results show that coordination and cooperation, information and communication mechanisms, and organisational operating environment are among the most important factors, based on the AISM hierarchy. This study will help policy makers to effectively identify vulnerabilities in emergency logistics supply chains and develop stronger strategies to build more resilient supply chains thereby helping to reduce the losses to society caused by disasters.
This new diagnostic consensus guideline is a joint project of the European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR] that now merges the former ECCO-ESGAR Imaging Guideline and the former ECCO Endoscopy Guideline, also including laboratory parameters. It has been drafted by 30 ECCO and ESGAR members from 17 European countries. All the authors recognize th e work of and are grateful to previous ECCO and ESGAR members who contributed tocreating the earlier consensus guidelines on imaging and endoscopy. The former guidelines have been condensed into this new diagnostic consensus guideline which consists of two papers: the first detailing assessment at initial diagnosis, to monitor treat ment and for the detection of complications; the second dealing with the available scoring systems and general considerations regarding the different diagnostic tools. The strategy to define consensus was similar to that previously described in other ECCO consensus guidelines [available at www.ecco-ibd.eu]. Briefly, an open call for participants was made, with ECCO participants selected by the Guidelines’ Committee of ECCO [known as GuiCom] on the basis of their publication record and a personal statement and ESGAR participants nominated by ESGAR. The following working parties were established: diagnostics at initial diagnosis, diagnostics for monitoring treatment in patients with known IBD, diagnostics for the detect ion of complications, scores for IBD, and general principles and technical aspects. Provisional guideline statements and supporting text were written following a comprehensive literature review, then refined following two voting rounds. The first voting round introduced a more comprehensive voting procedure, in which each Guidelines participants voted on all statements by explicitly reviewing those statements together with their respective supporting text and references. The second voting round included optional national representative participation of ECCO’s 36 member countries and ESGAR’s 28 member countries. The level of evidence was graded according to the Oxford Centre for Evidence-Based Medicine [www.cebm.net]. The ECCO statements were finalized by the authors at a face-to-face meeting in Barcelona in October 2017 and represent consensus with agreement of at least 80% of the present participants. Consensus statements are intended to be read in context with their qualifying comments and not in isolation. The supporting text was then finalised under the direction of each working group leader [SV, TK, GF, VA, EC], before being integrated by the consensus leaders [CM, JS, AS].
What you need to know<br/> Early symptoms of brain tumours in adults are non-specific, and patients may present multiple times to primary care services before they are referred for investigation. Look for symptoms of raised intracranial pressure (such as headaches exacerbated by lying down, triggered by the Valsalva manoeuvre, or associated with vomiting or visual disturbance), combinations of symptoms (such as headache plus cognitive impairment, headache plus weakness, headache plus personality change), and symptoms that progress over time. New onset focal or generalised seizures in adulthood also warrant investigation for a brain tumour.<br/> In patients with symptoms or signs suggestive of a brain tumour, arrange urgent magnetic resonance imaging of the head with and without contrast through a rapid access “suspected cancer” pathway, when available. In patients with suspicion of raised intracranial pressure, arrange a same day clinical assessment and contrast enhanced computed tomography of the head.<br/> Glioblastoma is the most common primary brain cancer. Standard treatment includes maximal safe resection followed by concomitant radiotherapy and temozolomide chemotherapy and then adjuvant temozolomide. Disease progression is expected in all cases and consideration of further treatment should take into account the patient’s performance status, tumour size, tumour location, and time since first treatment.<br/> Key supportive medications may include corticosteroids for vasogenic oedema and antiepileptic medication if seizures occur.<br/> Because of the incurable and rapidly progressive nature of glioblastoma, close collaboration between multidisciplinary teams in tertiary care hospitals and primary care services is recommended. Early involvement of general practitioners and specialist community palliative care teams can assist patients and caregivers with advance care planning as well as management of symptoms, physical and cognitive impairment, communication difficulties, and the innate uncertainties about disease progression.